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Walmart Pharmacy 10-7611
CAH141300-00 THOMAS H BOYD CRITICAL ACC HOSPITAL
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Covered Entity Details
Entity Name
THOMAS H BOYD CRITICAL ACC HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141300-00
Entity Address
800 SCHOOL STREET
CARROLLTON, IL 62016
Medicare Provider Number
141300
Participating Start Date
10/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donna Dewitt, CEO
(217) 942-6946 Ext: 1201
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/4/2024
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